NPIMap

Organization Active NPI

Peace Connection PLLC

  • Clinical Social Worker
  • Mystic, CT
National Provider Identifier
1306564976
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
PEACE CONNECTION PLLC
Practice address
12 Roosevelt Ave Ste 2
Mystic, CT 06355-2832
Phone
(860) 485-7992
NPI assigned
Aug 18, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeannine Cleaver, LCSWNPI 1336591924
Title
Owner
Phone
(860) 245-9840

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

12 Roosevelt Ave Ste 2
Mystic, CT 06355-2832

Mailing address

11 Boston Post Rd FL 2
Waterford, CT 06385-2401

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250304003361 CT Part B Supplier - Clinic/Group Practice 7214458439 Receives reassigned benefits from 5 practitioners
Practice locations: Mystic, CT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1660780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737504000000",
    "number": "1306564976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 BOSTON POST RD FL 2",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "063852401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 ROOSEVELT AVE STE 2",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063552832",
            "telephone_number": "860-485-7992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACE CONNECTION PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-18",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A",
        "authorized_official_last_name": "CLEAVER",
        "authorized_official_first_name": "JEANNINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-245-9840",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mystic, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.